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Assem A, Kassem A, Sherif M, Lotfi A, Abdelwahed M. Safety, feasibility, and quality of thulium laser en-bloc resection for treatment of non-muscle invasive bladder cancer. Int Urol Nephrol 2023; 55:3103-3109. [PMID: 37639155 PMCID: PMC10611837 DOI: 10.1007/s11255-023-03752-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Trans-Urethral Resection of Bladder Tumors (TURBT) is a critical step in diagnosis, staging and treatment of bladder tumors. Conventional TURBT (cTURBT) involves the electro-resection of the tumor into small fragments. This technique leads to concerns about the completeness of resection, under-staging, bleeding, cancer cell implantation, and most importantly, risk of tumour recurrence. To circumvent this, laser en-bloc resection of bladder tumors has been introduced. OBJECTIVES Assessment of the safety, feasibility, and quality of Thulium Laser En-bloc Resection of Tumors (TmL-ERBT) for treatment of Non-Muscle Invasive Bladder Cancer (NMIBC) in various urinary bladder walls as a primary endpoint. The secondary endpoints were to investigate the feasibility of thulium laser use in the re-staging cystoscopy and to evaluate the learning curve of TmL-ERBT. METHODS This is a prospective observational study including all newly diagnosed patients, above 18 years old, with a urinary bladder mass ≤ 4 cm in maximal dimension (measured via bladder ultrasound or CT or MRI). All patients underwent TmL-ERBT under regional anaesthesia in a lithotomy position. All intraoperative complications such as obturator nerve reflex, bladder perforation, and significant bleeding were recorded. Postoperative variables such as the mean catheterization time, bladder irrigation fluid volume and duration, and the mean of hospital stay as well as the postoperative complications were recorded. All patients were risk stratified and managed according to EUA guidelines then followed by a surveillance regimen per 3 months for 6 months. RESULTS The study included 23 patients with a mean age of 53 ± 15.8 years. While 15 patients (65%) had a single tumor, the rest had multiple tumors, ranging from 2 to 3 in number with a total of 36 lesions. No cases required conversion to cTURBT and none of them experienced obturator nerve reflex or bladder perforation. Only one patient (4.3%) had an attack of clot urine retention. The mean hospitalization time was 31.2 ± 14.4 h and the mean catheterization time was 20.4 ± 13.3 h. The Detrusor muscle was present in 20 patients (87%) and the remaining 3 patients required a re-staging cystoscopy which was performed efficiently using thulium laser. None of the treated patients developed tumour recurrence during the follow-up period. In analysis, the duration of complete resection of 2-4 cm tumours was 23-27 min after the 7th case with a resection rate of 0.12-0.15 cm/min. CONCLUSION TmL-ERBT is safe and feasible for complete resection of NMIBC with a short learning curve and adequate cancer control.
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Affiliation(s)
- Ahmed Assem
- Faculty of Medicine, Kasr Alainy hospitals, Cairo University, Cairo, Egypt
| | - Ayman Kassem
- Faculty of Medicine, Kasr Alainy hospitals, Cairo University, Cairo, Egypt
| | - Mohamed Sherif
- Faculty of Medicine, Kasr Alainy hospitals, Cairo University, Cairo, Egypt
| | - Amr Lotfi
- Faculty of Medicine, Kasr Alainy hospitals, Cairo University, Cairo, Egypt
| | - Mohamed Abdelwahed
- Faculty of Medicine, Kasr Alainy hospitals, Cairo University, Cairo, Egypt.
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Herrmann TRW. En bloc resection of bladder tumors (ERBT) revisited 12 years after reintroduction: too good to be further ignored. World J Urol 2023; 41:2577-2582. [PMID: 37819587 DOI: 10.1007/s00345-023-04629-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
En bloc resection of bladder tumors (ERBT) orginally described in 1980 and adopted by few centers in the late 1990s has regained attention in the 2010s as a renaissance of a technique with high potential. The advent of new lasers indirectly lead to a better understanding of anatomical dissection from the experience in anatomical dissection in endoscopic enucleation of the prostate. 12 years after the reintroduction of ERBT evidence mounts that it is not only equivalent but better in some regards. However, ERBT still falls short with regard to wide adoption despite the striking technique inherent and reproducible features of accurate staging and specimen quality as requested by pathologist, as well and despite the high intraoperative safety and fast adoption of this technique even in early phase of training. The editorial walks the reader through the timeline of the renaissance speculating why there is a blockage between cognitive understanding and dissonance in surgical practice. The special issues presents the meta-analysis of surgical and oncological data on one hand and the level of understanding and power of this surgical technique in fields offsite oncological results in training achieving results almost right from the start after adoptation. Unlike in earlier years reviewing the literature of ERBT in 2023, ERBT seems not only to be a viable alternative, but something one should turn towards no to underperform with regards to the endpoints achievable by ERBT in a critical disease like bladder cancer.
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Affiliation(s)
- Thomas R W Herrmann
- Department of Urology, Spital Thurgau AG, Kantonsspital Frauenfeld, Pfaffenholzstrasse 4, CH 8501, Frauenfeld, Switzerland.
- Division of Urology, Department of Surgical Sciences, Stellenbosch University, Western Cape, South Africa.
- Hannover Medical School, Hannover, Germany.
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Marcq G, Vernooij RWM, Alvez GA, Escobar Liquitay CM, Dahm P. En bloc versus standard transurethral resection of bladder tumors for non‐muscle‐invasive bladder cancer patients. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2022; 2022:CD015105. [PMCID: PMC9633077 DOI: 10.1002/14651858.cd015105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of en bloc resection compared with conventional transurethral resection of the bladder tumor (conventional TURBT) in patients with non‐muscle‐invasive bladder cancer.
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Affiliation(s)
| | - Gautier Marcq
- Urology DepartmentClaude Huriez Hospital, CHU LilleLilleFrance,UMR9020-U1277 – CANTHER - Cancer Heterogeneity Plasticity and Resistance to TherapiesUniversité de Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de LilleLilleFrance
| | - Robin WM Vernooij
- Department of Nephrology and Hypertension and Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtNetherlands
| | - Gustavo Ariel Alvez
- Cochrane Center Instituto Universitario Hospital Italiano de Buenos AiresInstituto Universitario Hospital Italiano de Buenos AiresCiudad Autónoma de Buenos AiresArgentina
| | | | - Philipp Dahm
- Urology SectionMinneapolis VA Health Care SystemMinneapolisMinnesotaUSA
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Effectiveness of Early Radical Cystectomy for High-Risk Non-Muscle Invasive Bladder Cancer. Cancers (Basel) 2022; 14:cancers14153797. [PMID: 35954460 PMCID: PMC9367342 DOI: 10.3390/cancers14153797] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/24/2022] [Accepted: 08/01/2022] [Indexed: 02/04/2023] Open
Abstract
Purpose: The purpose of this study is to compare perioperative and oncological outcomes of upfront vs. delayed early radical cystectomy (eRC) for high-risk non-muscle-invasive bladder cancer (HR-NMIBC). Methods: All consecutive HR-NMIBC patients who underwent eRC between 2001 and 2020 were retrospectively included and divided into upfront and delayed groups, according to the receipt or not of BCG. Perioperative outcomes were evaluated and the impact of upfront vs. delayed eRC on pathological upstaging, defined as ≥pT2N0 disease at final pathology, was assessed using multivariable logistic regression. Recurrence-free (RFS), cancer-specific (CSS) and overall survival (OS) were compared between upfront and delayed eRC groups using inverse probability of treatment weighting (IPTW)-adjusted Cox model. Results: Overall, 184 patients received either upfront (n = 87; 47%) or delayed (n = 97; 53%) eRC. No difference was observed in perioperative outcomes between the two treatment groups (all p > 0.05). Pathological upstaging occurred in 55 (30%) patients and upfront eRC was an independent predictor (HR = 2.65; 95% CI = (1.23−5.67); p = 0.012). In the IPTW-adjusted Cox analysis, there was no significant difference between upfront and delayed eRC in terms of RFS (HR = 1.31; 95% CI = (0.72−2.39); p = 0.38), CSS (HR = 1.09; 95% CI = (0.51−2.34); p = 0.82) and OS (HR = 1.19; 95% CI = (0.62−2.78); p = 0.60). Conclusion: our results suggest similar perioperative outcomes between upfront and delayed eRC, with an increased risk of upstaging after upfront eRC that did impact survival, as compared to delayed eRC.
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Symeonidis EN, Lo KL, Chui KL, Vakalopoulos I, Sountoulides P. En bloc resection of bladder tumors: challenges and unmet needs in 2021. Future Oncol 2022; 18:2545-2558. [PMID: 35642479 DOI: 10.2217/fon-2021-1228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Non-muscle invasive bladder cancer accounts for the majority of new bladder cancer diagnoses, and endoscopic transurethral resection of bladder tumor (TURBT) represents the standard-of-care. Although a relatively safe and common procedure, TURBT is often hampered by the questionable quality of resection. The evolution of surgical techniques has brought en bloc resection of bladder tumor (ERBT) to the forefront. ERBT has emerged as an alternative to conventional TURBT, incorporating a more delicate en bloc sculpting and tumor excision, in contrast to 'piecemeal' resection by conventional TURBT. ERBT appears safe, feasible and effective with demonstrably higher rates of detrusor muscle in the pathologic specimen, all while providing better staging and obviating the need for a re-TURBT in selected patients. However, the method's adoption in the field is still limited. This review summarizes the recent evidence relevant to ERBT while further highlighting the technique's limitations and unmet needs.
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Affiliation(s)
- Evangelos N Symeonidis
- First Department of Urology, Aristotle University of Thessaloniki, School of Medicine, "G Gennimatas" General Hospital, Thessaloniki, 54635, Greece
| | - Ka-Lun Lo
- Department of Surgery, Division of Urology, The Chinese University of Hong Kong, Hong Kong SAR, The People's Republic of China
| | - Ka-Lun Chui
- Department of Surgery, Division of Urology, The Chinese University of Hong Kong, Hong Kong SAR, The People's Republic of China
| | - Ioannis Vakalopoulos
- First Department of Urology, Aristotle University of Thessaloniki, School of Medicine, "G Gennimatas" General Hospital, Thessaloniki, 54635, Greece
| | - Petros Sountoulides
- First Department of Urology, Aristotle University of Thessaloniki, School of Medicine, "G Gennimatas" General Hospital, Thessaloniki, 54635, Greece
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Oswald D, Pallauf P, Deininger S, Herrmann TRW, Netsch C, Becker B, Fiedler M, Haecker A, Homberg R, Klein JT, Lehrich K, Miernik A, Olbert P, Schöb DS, Sievert KD, Gross AJ, Westphal J, Lusuardi L. [Safety and efficacy of en bloc vs. conventional transurethral resection of bladder tumors: a meta-analysis and systematic review]. UROLOGIE (HEIDELBERG, GERMANY) 2022; 61:644-652. [PMID: 35286433 DOI: 10.1007/s00120-022-01765-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND En bloc tumor resection of bladder tumors (ERBT) is a novel alternative procedure to conventional resection of bladder tumor (cTURBT), which might help to address common problems of the standard method, such as inadequate detrusor muscle in specimens, high re-resection rates and high recurrence rates. OBJECTIVE To analyze current data on ERBT in efficacy and safety compared to cTURBT. DATA SOURCES PubMed. STUDY SELECTION Two independent authors identified trials based on keywords and inclusion criteria. A third author was consulted in case of discrepancies. Screening keywords: ERBT, en bloc transurethral resection of bladder tumor, TURBT en bloc. A meta-analysis of 13 studies was performed. The effect size was estimated based on odds ratios and mean differences including their corresponding two-sided 95% confidence intervals. DATA SYNTHESIS The analyzed studies comprised a homogenous collective in terms of tumor size, tumor multiplicity and tumor stage. Operation time did not significantly differ between the methods. Differences were observed in hospitalization and catheterization time in favor of ERBT. Reported complications did not show clear differences. There was significantly more detrusor muscle in the specimens in the ERBT group. No significant differences were found in recurrence up to 2 years of follow-up. CONCLUSION ERBT is a safe alternative to conventional TURBT with promising features regarding effective resection of detrusor muscle. More standardized data on recurrence rates, different resection modalities and resection margin results are needed.
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Affiliation(s)
- D Oswald
- Universitätsklink für Urologie und Andrologie, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich.
| | - P Pallauf
- Universitätsklink für Urologie und Andrologie, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
| | - S Deininger
- Universitätsklink für Urologie und Andrologie, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
| | | | - C Netsch
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Deutschland
| | - B Becker
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Deutschland
| | - M Fiedler
- Klinik für Urologie, SLK-Kliniken Heilbronn GmbH, Heilbronn, Deutschland
| | - A Haecker
- Klinik für Urologie und Kinderurologie, Gesundheitsverbund Landkreis Konstanz, Klinikum Konstanz, Konstanz, Deutschland
| | - R Homberg
- Klinik für Urologie, Kinderurologie und Uro-Gynäkologie, St. Barbara-Klinik Hamm-Heessen, Hamm, Deutschland
| | - J T Klein
- Urologische Klinik am Lerchenberg, Heilbronn, Deutschland
| | - K Lehrich
- Klinik für Urologie, Vivantes Auguste-Viktoria-Klinikum, Berlin, Deutschland
| | - A Miernik
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - P Olbert
- BRIXSANA private clinic, Brixen, Italien
| | - D S Schöb
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - K D Sievert
- UKOWL, Campus Klinikum Lippe, Detmold, Deutschland
| | - A J Gross
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Deutschland
| | - J Westphal
- Klinik für Urologie, Kinderurologie und Urogynäkologie, Krankenhaus Maria Hilf der Alexianer GmbH, Krefeld, Deutschland
| | - L Lusuardi
- Universitätsklink für Urologie und Andrologie, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
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Ragonese M, Dibitetto F, Bassi P, Pinto F. Laser technology in urologic oncology. Urologia 2022; 89:338-346. [PMID: 35422152 DOI: 10.1177/03915603221088721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Laser technology has been used in Urology since the 80s with a lot of different applications in endoscopic and open surgery. With the developments of the technology and the introduction of new active medium and source of laser energy, this technology have become the gold standard not only in stone surgery but even in benign prostate enlargement (BPE) surgical treatment. Regarding urologic oncology, laser energy has now reached an important role in focal therapy and in conservative treatment. The possibility of having better functional outcomes without any relevant impact on oncological results led to an increased use of laser in penile surgery, with a significant mention in urological guidelines for this option. In urothelial cancers as well, both in conservative management of upper tract tumors that in the treatment of non muscle invasive bladder cancer, a clear role of these relatively new source of energy have been demonstrated. Finally, both in prostate that in renal cancer the strategy of focal therapy may take advantage from this precise and fine technology. In this review we analyzed and described the applications of laser energy in urological cancers with a specific focus on penile, urothelial and prostate cancer.
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Affiliation(s)
- Mauro Ragonese
- Unit of Urology, Department of Surgical and Medical Sciences, University Hospital Agostino Gemelli-IRCCS, Rome, Italy
| | - Francesco Dibitetto
- Unit of Urology, Department of Surgical and Medical Sciences, University Hospital Agostino Gemelli-IRCCS, Rome, Italy
| | - PierFrancesco Bassi
- Unit of Urology, Department of Surgical and Medical Sciences, University Hospital Agostino Gemelli-IRCCS, Rome, Italy
| | - Francesco Pinto
- Unit of Urology, Department of Surgical and Medical Sciences, University Hospital Agostino Gemelli-IRCCS, Rome, Italy
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Fan J, Zhang X, Fan J, Li L, He D, Wu K. Risk Stratification for the Rate and Location of Residual Bladder Tumor for the Decision of Re-Transurethral Resection of Bladder Tumor. Front Oncol 2022; 12:788568. [PMID: 35155230 PMCID: PMC8829133 DOI: 10.3389/fonc.2022.788568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 01/07/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction To assess the rate and location of residual tumor in re-transurethral resection of bladder tumor (re-TURBT) and develop a risk stratification tool to assist clinicians in making treatment decisions. Patients and Methods The data of 144 patients with high-risk bladder cancer who received re-TURBT were retrospectively reviewed. The rate and location of residual tumors was recorded. Logistic regression was performed to explore risk factors for residual tumors, and a risk classification tool was developed. Results Among the 144 patients, the rates of residual tumor and tumor location at the base of the primary tumor were 22.2% and 10.4%, respectively. Non-urothelial carcinoma subspecialist, piecemeal resection and the absence of detrusor muscle in the first specimen were defined as risk factors. Patients were categorized into low-, intermediate-, and high-risk groups according to the number of risk factors. The rate of residual tumor in the high-risk group was significantly higher than that in the low- and intermediate-risk groups (50% vs. 7.8%, P=0.001; 50% vs. 18.6%, P=0.002). Moreover, high-risk patients benefitted more from a second resection at the base of the primary tumor due to the high rate of residual tumor located at this site than low- and intermediate-risk patients (23.5% vs. 2.0%, P=0.002; 23.5% vs. 10.2%, P=0.083). Conclusions Risk stratification based on the subspecialist category, operative method, and presence or absence of detrusor muscle in the first specimen could help identify patients who benefit from re-TURBT and second resection the base of the primary tumor.
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Affiliation(s)
- Junjie Fan
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Urology, Baoji Central Hospital, Baoji, China
| | - Xing Zhang
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jinhai Fan
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lei Li
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Dalin He
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Kaijie Wu
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Li L, Na R, Mi T, Cheng H, Ma L, Chen G. Medical Image Diagnostic Value of Computed Tomography for Bladder Tumors. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:3781028. [PMID: 34824598 PMCID: PMC8610659 DOI: 10.1155/2021/3781028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/21/2021] [Accepted: 10/18/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study computed tomography (CT) imaging characteristics of bladder tumors, to explore the value of CT in tumor diagnosis, and to identify the relevant factors of CT missed diagnosis so that medical staff can be more accurate in the diagnosis of bladder tumors. METHODS To retrospectively analyze the CT manifestations of 153 bladder tumor cases confirmed by paraffin pathology in our hospital and to study the difference between the benign and CT imaging features. CT indicators mainly include the number, location, morphology, calcification, bladder wall smoothness, CT value, degree of enhancement, and invasion of surrounding tissues and organs. Then, we retrospectively analyze 17 cases of CT missed diagnosis of bladder tumors, analyze related factors, and discuss the role of CT in the diagnosis of bladder tumors. RESULTS This study has shown that with the help of CT images, the diagnosis rate of bladder tumors has been greatly improved. Of the 153 patients studied, noninvasive urothelial carcinoma accounted for 18.95% of all benign and malignant bladder tumors, invasive urothelial carcinoma accounted for 67.93%, prostatic metastatic carcinoma and inflammatory myofibroblastoma accounted for 8.47%, pheochromocytoma accounted for 1.31%, inverted papilloma accounted for 1.31%, tubular choriocarcinoma accounted for 0.63%, and endocystitis accounted for 1.31%. In addition, the blood supply level, CT index bladder wall smoothness, and CT value are also statistically significant (P < 0.05). CONCLUSIONS CT is of high value in the diagnosis of bladder tumors, and benign and malignant bladder tumors have CT and CT imaging features. The size of bladder tumors is related to the missed diagnosis rate of CT. The application of CT examination technology can improve the accuracy of diagnosis of bladder tumors.
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Affiliation(s)
- Lin Li
- Graduate School of the Affiliated Hospital of Qinghai University, Graduate School, Xining, Qinghai 810000, China
| | - Risu Na
- Graduate School of the Affiliated Hospital of Qinghai University, Graduate School, Xining, Qinghai 810000, China
| | - Tao Mi
- Graduate School of the Affiliated Hospital of Qinghai University, Graduate School, Xining, Qinghai 810000, China
| | - Hao Cheng
- Graduate School of the Affiliated Hospital of Qinghai University, Graduate School, Xining, Qinghai 810000, China
| | - Lili Ma
- Qinghai University, Xining, Qinghai 810000, China
| | - Guojun Chen
- Department of Urology, Affiliated Hospital of Qinghai University, Xining, Qinghai 810000, China
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Nielsen NK, Jakobsen JK, Kingo PS, Jensen JB. Potential candidates for en bloc resection among patients with primary and recurrent bladder tumours. Scand J Urol 2021; 55:366-371. [PMID: 34279178 DOI: 10.1080/21681805.2021.1954686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Transurethral resection (TURB) is the gold standard treatment for non-muscle invasive bladder cancer (NMIBC). However, conventional TURB is possibly part of the mechanism leading to the high recurrence rate in NMIBC and the need for repeated procedures, as the method with piecemeal resection of the tumour violates basic oncological principles and compromises pathological examination. En bloc resection (EBR) could potentially overcome these flaws by improving pathological quality and thereby reducing the need for re-resections and could potentially also lower the risk of tumour seeding leading to early recurrences. With this study, we aimed to evaluate tumour characteristics in a consecutive cohort of patients undergoing conventional TURB in order to estimate the proportion of procedures eligible for EBR, findings at re-resection, and early recurrence rate. METHODS All TURBs performed at a single large University Hospital in a 12 month period were manually reviewed. Based on tumour size and appearance, patients were registered as candidates or non-candidate for EBR. RESULTS A total of 600 TURBs were reviewed. Overall, 25% of procedures were found to be eligible for EBR. The most frequent reason for not being a candidate was tumour diameter <1 cm. Re-resections were done after 10.5% of the procedures, where the residual tumour was found in 28.6% of these. Within 6 months, 21.2% had a recurrence. CONCLUSION We found approximately 25% of all TURBs to be eligible for EBR. Based on a relatively low recurrence rate, we conclude that future studies on EBR with recurrence rate as the primary endpoint will require large patient cohorts.
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Compérat EM, Al-Ahmadie H. Pathology. Bladder Cancer 2021. [DOI: 10.1007/978-3-030-70646-3_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
PURPOSE OF REVIEW En bloc resection of bladder tumor (ERBT) is an innovative new surgical technique, the use of which is becoming increasingly widespread. In this review, we analyze the recent literature and explore new developments, which may impact the future role of en bloc bladder surgery. RECENT FINDINGS ERBT increases the frequency with which detrusor muscle is present in the specimen (to 95%) and offers a significant improvement in the quality of the resection specimen, thereby helping with T1 substaging. Furthermore, the laser treatment reduces the rate of obturator nerve-related bladder perforation. SUMMARY ERBT represents a considerable advancement in the surgical management of nonmuscle-invasive bladder cancer. It delivers excellent oncological results and is a well tolerated procedure. VIDEO In the accompanying video, we shortly report the different modalities and energy sources used for bladder cancer resection. The three strategies are currently employed at the Fundació Puigvert (Barcelona). VIDEO ABSTRACT:.
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Rouprêt M, Neuzillet Y, Pignot G, Compérat E, Audenet F, Houédé N, Larré S, Masson-Lecomte A, Colin P, Brunelle S, Xylinas E, Roumiguié M, Méjean A. French ccAFU guidelines – Update 2018–2020: Bladder cancer. Prog Urol 2020; 28:R48-R80. [PMID: 32093463 DOI: 10.1016/j.purol.2019.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 07/30/2018] [Indexed: 12/27/2022]
Abstract
Objective To propose updated French guidelines for non-muscle invasive (NMIBC) and muscle-invasive (MIBC) bladder cancers. Methods A Medline search was achieved between 2015 and 2018, as regards diagnosis, options of treatment and follow-up of bladder cancer, to evaluate different references with levels of evidence. Results Diagnosis of NMIBC (Ta, T1, CIS) is based on a complete deep resection of the tumor. The use of fluorescence and a second-look indication are essential to improve initial diagnosis. Risks of both recurrence and progression can be estimated using the EORTC score. A stratification of patients into low, intermediate and high risk groups is pivotal for recommending adjuvant treatment: instillation of chemotherapy (immediate post-operative, standard schedule) or intravesical BCG (standard schedule and maintenance). Cystectomy is recommended in BCG-refractory patients. Extension evaluation of MIBC is based on contrast-enhanced pelvic-abdominal and thoracic CT-scan. Multiparametric MRI can be an alternative. Cystectomy associated with extended lymph nodes dissection is considered the gold standard for non-metastatic MIBC. It should be preceded by cisplatin-based neoadjuvant chemotherapy in eligible patients. An orthotopic bladder substitution should be proposed to both male and female patients with no contraindication and in cases of negative frozen urethral samples; otherwise transileal ureterostomy is recommended as urinary diversion. All patients should be included in an Early Recovery After Surgery (ERAS) protocol. For metastatic MIBC, first-line chemotherapy using platin is recommended (GC or MVAC), when performans status (PS < 1) and renal function (creatinine clearance > 60 mL/min) allow it (only in 50 % of cases). In second line treatment, immunotherapy with pembrolizumab demonstrated a significant improvement in overall survival. Conclusion These updated French guidelines will contribute to increase the level of urological care for the diagnosis and treatment for NMIBC and MIBC.
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Affiliation(s)
- M Rouprêt
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,GRC no 5, ONCOTYPE-URO, hôpital Pitié-Salpêtrière, Sorbonne université, AP–HP, 75013 Paris, France
| | - Y Neuzillet
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service d’urologie, hôpital Foch, université de Versailles-Saint-Quentin-en-Yvelines, 92150 Suresnes, France
| | - G Pignot
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service de chirurgie oncologique 2, institut Paoli-Calmettes, 13008 Marseille, France
| | - E Compérat
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service d’anatomie pathologique, GRC no 5, ONCOTYPE-URO, hôpital Tenon, HUEP, Sorbonne université, AP-HP, 75020 Paris, France
| | - F Audenet
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service d’urologie, hôpital européen Georges-Pompidou, université Paris Descartes, AP–HP, 75015 Paris, France
| | - N Houédé
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Département d’oncologie médicale, CHU Caremaux, Montpellier université, 30000 Nîmes, France
| | - S Larré
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service d’urologie, CHU de Reims, Reims, 51100 France
| | - A Masson-Lecomte
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service d’urologie, hôpital Saint-Louis, université Paris-Diderot, AP–HP, 75010 Paris, France
| | - P Colin
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service d’urologie, hôpital privé de la Louvière, 59800 Lille, France
| | - S Brunelle
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service de radiologie, institut Paoli-Calmettes, 13008 Marseille, France
| | - E Xylinas
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service d’urologie de l’hôpital Bichat-Claude-Bernard, université Paris-Descartes, AP–HP, 75018 Paris, France
| | - M Roumiguié
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Département d’urologie, CHU Rangueil, Toulouse, 31000 France
| | - A Méjean
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service d’urologie, hôpital européen Georges-Pompidou, université Paris Descartes, AP–HP, 75015 Paris, France
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14
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Xu J, Wang C, Ouyang J, Sun J, Hu C. Efficacy and Safety of Transurethral Laser Surgery Versus Transurethral Resection for Non-Muscle-Invasive Bladder Cancer: A Meta-Analysis and Systematic Review. Urol Int 2020; 104:810-823. [PMID: 32460292 DOI: 10.1159/000506655] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 02/18/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare the efficacy and safety of transurethral laser surgery and transurethral resection of a bladder tumor (TURBT) for non-muscle-invasive bladder cancer (NMIBC). MATERIAL AND METHODS A research was carried out in Medline via PubMed, EMBASE, the Cochrane Library, and Web of Science up to October 20, 2019, to identify articles related to transurethral laser surgery and TURBT for NMIBC. All analyses were done using RevMan5.3 and Stata14. RESULTS A total of 17 studies involving 2,439 participants were included. The analysis showed no significant difference in operation times (mean difference = -0.2; 95% CI -2.29 to 1.89; p = 0.85) or occurrences of urethral stricture (OR = 0.7; 95% CI 0.24-2.06; p = 0.52). Transurethral laser surgery was associated with a lower incidence of obturator nerve reflex (OR = 0.04; 95% CI 0.02-0.09; p < 0.00001) and bladder perforation (OR = 0.09; 95% CI 0.04-0.23; p < 0.00001), a higher rate of detrusor muscle acquisition (OR = 5.28; 95% CI 2.42-11.49; p < 0.0001), shorter catheterization (mean difference = -1.05; 95% CI -1.41 to -0.68; p < 0.00001) and hospitalization times (mean difference = -0.96; 95% CI -1.59 to -0.33; p = 0.003), and lower rates of bladder irrigation (OR = 0.21; 95% CI 0.13-0.35; p < 0.00001) and recurrence both at 12 months (OR = 0.66; 95% CI 0.48-0.9, p = 0.008) and at 24 months (OR = 0.6; 95% CI 0.41-0.86; p = 0.005). CONCLUSIONS Transurethral laser surgery for NMIBC, as compared to TURBT, is associated with a lower incidence of complications, a lower recurrence rate, and faster postoperative recovery.
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Affiliation(s)
- Jiangnan Xu
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chao Wang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jun Ouyang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China,
| | - Jiale Sun
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Can Hu
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, China
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15
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Zhou W, Wang W, Wu W, Yan T, Du G, Liu H. Can a second resection be avoided after initial thulium laser endoscopic en bloc resection for non-muscle invasive bladder cancer? A retrospective single-center study of 251 patients. BMC Urol 2020; 20:30. [PMID: 32188429 PMCID: PMC7081553 DOI: 10.1186/s12894-020-00599-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 03/09/2020] [Indexed: 11/12/2022] Open
Abstract
Background This study aimed to evaluate the efficacy of transurethral thulium laser en bloc resection of the bladder tumor (TmLRBT) in patients with non-muscle invasive bladder cancer (NMIBC) and to investigate whether a second resection can be avoided. Methods From June 2012 to June 2018, 251 newly diagnosed patients with NMIBC were enrolled in this retrospective study; all patients received regular administration of pirarubicin after the initial resection. A second transurethral resection (TUR) was performed in patients within 2–6 weeks after the initial TmLRBT in group 1. Patients in group 2 only underwent cystoscopy at 3 months. Results Second surgery results indicate that recurrence was detected histopathologically in 6/108 and 11/143 patients in group 1 and 2, respectively (P = 0.52); Progression was observed in 2 patients in each group (P = 0.34). The mean follow-up duration was 40.1 months, with no significant difference between the groups (P = 0.32). Recurrence was observed in 23 (21.3%) and 39 (27.3%) patients in groups 1 and 2 during the follow-up, respectively (P = 0.34); disease progression occurred in 4 (3.8%) patients in group 1 compared with 7 (4.0%) in group 2 (P = 0.20). Conclusion Complete removal of tumors can be achieved by TmLRBT. This technique may decrease the number of second TURs.
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Affiliation(s)
- Wenhao Zhou
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No.100, Haining Road, Shanghai, 200080, China
| | - Wei Wang
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No.100, Haining Road, Shanghai, 200080, China
| | - Wenbo Wu
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No.100, Haining Road, Shanghai, 200080, China
| | - Tingmang Yan
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No.100, Haining Road, Shanghai, 200080, China
| | - Guofang Du
- Weifang Second People's Hospital, No.7 YuanXiao Street, Kuiwen District, WeiFang City, 261041, ShanDong Province, China
| | - Haitao Liu
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No.100, Haining Road, Shanghai, 200080, China.
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16
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Eissa A, Zoeir A, Ciarlariello S, Sarchi L, Sighinolfi MC, Ghaith A, Puliatti S, Inzillo R, Reggiani Bonetti L, Rizzo M, Rocco B, Micali S. En-bloc resection of bladder tumors for pathological staging: the value of lateral margins analysis. MINERVA UROL NEFROL 2020; 72:763-769. [PMID: 32003203 DOI: 10.23736/s0393-2249.20.03551-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In endoscopic resection of colorectal tumors, the pathological assessment of the lateral margins is a strong predictor of tumor recurrence after resection. The aim of the current study is to evaluate the value of the peritumoral margins assessment in ERBT on tumor recurrence. METHODS We retrospectively analyzed the data of 50 consecutive patients with NMIBC and treated by ERBT between January and December 2017. RESULTS The lateral margins showed dysplasia in 16 patients and malignancy in three patients. Local recurrence occurred in 14 (28%) patients. It was noted that 57% of patients with recurrence showed some degree of dysplasia or malignancy in the lateral margin; however, on multivariate logistic regression lateral margins lesions were not significantly associated with recurrence (OR 2.175, 95% CI: 0.430-10.996, P=0.35). CONCLUSIONS ERBT may improve the pathological report of bladder tumor. There was a trend toward increased rate of recurrence in patients with dysplasia or malignancy in their lateral margins; however, this was not statistically significant on multivariate analysis. Further studies with larger sample sizes are required to assess the value of lateral margin analysis.
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Affiliation(s)
- Ahmed Eissa
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.,Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed Zoeir
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.,Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Silvia Ciarlariello
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Sarchi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria C Sighinolfi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Ahmed Ghaith
- Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Raffaele Inzillo
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Reggiani Bonetti
- Section of Pathology, Department of Diagnostic Medicine and Public Health, University of Modena and Reggio Emilia, Modena, Italy
| | - Mino Rizzo
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Bernardo Rocco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy -
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17
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Yang H, Lin J, Gao P, He Z, Kuang X, Li X, Fu H, Du D. Is the En Bloc Transurethral Resection More Effective than Conventional Transurethral Resection for Non-Muscle-Invasive Bladder Cancer? A Systematic Review and Meta-Analysis. Urol Int 2020; 104:402-409. [PMID: 31910427 DOI: 10.1159/000503734] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 09/25/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND En bloc transurethral resection (ERBT) is a major topic of discussion as an alternative to conventional transurethral resection (cTURBT) for the treatment of non-muscle-invasive bladder cancer (NMIBC) addressing the limitations of cTURBT. METHODS We searched through electronic databases including Embase, Cochrane Library, MEDLINE, Web of Science, PubMed, and Google Scholar for articles published up to April 1, 2019; RevMan 5.3 was used to conduct this meta-analysis. Results were expressed as 95% confidence intervals (CI) and risk differences (RD). RESULTS Nine trials met the inclusion criteria (n = 1,020 patients): 1 study was a randomized controlled trial including a total of 142 participants, 4 studies had a prospective paired design including 605 patients, and 4 studies were retrospective (n = 273 patients). Duration of continuous postoperative bladder irrigation (RD -0.16; 95% CI -3.47 to 0.28; I2 = 97%; p = 0.10) and operation time (RD 0.05; 95% CI -0.23 to 0.32; I2 = 79%; p = 0.74) were not significantly different between ERBT and cTURBT. However, hospitalization time (I2 = 96%; χ2 = 203.16; p = 0.01) and catheterization time (I2 = 95%; χ2 = 163.24; p = 0.02), as well as 24-month recurrence rate (I2 = 0%; χ2 = 0.98; p = 0.008) were significantly better using the ERBT scheme. The incidence of urethral stricture between both schemes (95% CI -0.03 to 0.02; p = 0.50) was not different, but complications such as obturator nerve reflex (95% CI 0.01 to 0.12; p < 0.00001) and bladder perforation (95% CI 0.05 to 0.59; p = 0.50) were less frequent in the ERBT group. CONCLUSION ERBT is an effective treatment approach with some advantages for NMIBC. Our meta-analysis revealed that hospitalization time, catheterization time, and 24-month recurrence rate is superior in patients treated with ERBT than cTURBT, and ERBT patients also have a lower complication rate. Furthermore, ERBT improves the quality of tumor specimens and decreases the frequency of repeat transurethral bladder cancer resection. Further randomized controlled trials are needed to confirm our results.
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Affiliation(s)
- Han Yang
- Department of Urology, Second People's Hospital of Yichang, Second People's Hospital of China Three Gorges University, Yichang, China
| | - Jingyu Lin
- Department of Gynecology and Obstetrics, Binhai Hospital, Tianjin Medical University General Hospital, Tianjin, China
| | - Pan Gao
- Department of Urology, Second People's Hospital of Yichang, Second People's Hospital of China Three Gorges University, Yichang, China
| | - Ziqiu He
- Department of Urology, Second People's Hospital of Yichang, Second People's Hospital of China Three Gorges University, Yichang, China
| | - Xiayu Kuang
- Department of Urology, Second People's Hospital of Yichang, Second People's Hospital of China Three Gorges University, Yichang, China
| | - Xinyu Li
- Department of Urology, Second People's Hospital of Yichang, Second People's Hospital of China Three Gorges University, Yichang, China
| | - Haibo Fu
- Department of Urology, Second People's Hospital of Yichang, Second People's Hospital of China Three Gorges University, Yichang, China
| | - Dan Du
- Department of Urology, Second People's Hospital of Yichang, Second People's Hospital of China Three Gorges University, Yichang, China,
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18
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van Putten K, Vernooij RWM, Meijer RP, Zhu X. En-bloc resection versus conventional transurethral resection for patients with non-muscle-invasive bladder cancer. Hippokratia 2019. [DOI: 10.1002/14651858.cd013473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Kim van Putten
- University Medical Center Utrecht; Department of Oncological Urology; Heidelberglaan 100 Utrecht Netherlands 3584 CX
| | - Robin WM Vernooij
- University Medical Center Utrecht; Department of Nephrology and Hypertension and Julius Center for Health Sciences and Primary Care; Heidelberglaan 100 Utrecht Netherlands 3584 CX
| | - Richard P Meijer
- University Medical Center Utrecht; Department of Oncological Urology; Heidelberglaan 100 Utrecht Netherlands 3584 CX
| | - Xiaoye Zhu
- Radboudumc, University Medical Center; Department of Urology; Nijmegen Netherlands
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19
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Rouprêt M, Neuzillet Y, Pignot G, Compérat E, Audenet F, Houédé N, Larré S, Masson-Lecomte A, Colin P, Brunelle S, Xylinas E, Roumiguié M, Méjean A. RETRACTED: Recommandations françaises du Comité de Cancérologie de l’AFU — Actualisation 2018—2020 : tumeurs de la vessie French ccAFU guidelines — Update 2018—2020: Bladder cancer. Prog Urol 2018; 28:S46-S78. [PMID: 30366708 DOI: 10.1016/j.purol.2018.07.283] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 07/30/2018] [Indexed: 12/24/2022]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy).
Cet article est retiré de la publication à la demande des auteurs car ils ont apporté des modifications significatives sur des points scientifiques après la publication de la première version des recommandations.
Le nouvel article est disponible à cette adresse: doi:10.1016/j.purol.2019.01.006.
C’est cette nouvelle version qui doit être utilisée pour citer l’article.
This article has been retracted at the request of the authors, as it is not based on the definitive version of the text because some scientific data has been corrected since the first issue was published.
The replacement has been published at the doi:10.1016/j.purol.2019.01.006.
That newer version of the text should be used when citing the article.
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Affiliation(s)
- M Rouprêt
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Sorbonne université, GRC no5, ONCOTYPE-URO, hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France.
| | - Y Neuzillet
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Foch, université de Versailles-Saint-Quentin-en-Yvelines, 92150 Suresnes, France
| | - G Pignot
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de chirurgie oncologique 2, institut Paoli-Calmettes, 13008 Marseille, France
| | - E Compérat
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'anatomie pathologique, hôpital Tenon, HUEP, Sorbonne université, GRC no5, ONCOTYPE-URO, 75020 Paris, France
| | - F Audenet
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, université Paris Descartes, AP-HP, 75015 Paris, France
| | - N Houédé
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Département d'oncologie médicale, CHU Caremaux, Montpellier université, 30000 Nîmes, France
| | - S Larré
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Reims, Reims, 51100 France
| | - A Masson-Lecomte
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Saint-Louis, université Paris-Diderot, 75010 Paris, France
| | - P Colin
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital privé de la Louvière, 59800 Lille, France
| | - S Brunelle
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, institut Paoli-Calmettes, 13008 Marseille, France
| | - E Xylinas
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie de l'hôpital Bichat-Claude-Bernard, université Paris-Descartes, Assistance publique-Hôpitaux de Paris, 75018 Paris, France
| | - M Roumiguié
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Département d'urologie, CHU Rangueil, Toulouse, 31000 France
| | - A Méjean
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, université Paris Descartes, AP-HP, 75015 Paris, France
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20
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Li K, Xu Y, Tan M, Xia S, Xu Z, Xu D. A retrospective comparison of thulium laser en bloc resection of bladder tumor and plasmakinetic transurethral resection of bladder tumor in primary non-muscle invasive bladder cancer. Lasers Med Sci 2018; 34:85-92. [PMID: 30171441 DOI: 10.1007/s10103-018-2604-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/31/2018] [Indexed: 11/25/2022]
Abstract
Bladder cancer is currently considered the most common malignancy of the urinary tract. Thulium laser en bloc resection of bladder tumor (TmLRBT) and plasmakinetic transurethral resection of bladder tumor (PK-TURBT) are two alternative common procedures used in our department to manage patients with primary non-muscle invasive bladder cancer (NMIBC) over the past decade. In this work, the safety and efficacy of TmLRBT were retrospectively compared to those of PK-TURBT in patients with primary NMIBC. From January 2013 to December 2015, 256 patients diagnosed with primary NMIBC were selected for this retrospective study. A total of 136 consecutive patients diagnosed with primary NMIBC were enrolled in the TmLRBT group. A similar historical cohort of 120 consecutive patients who underwent PK-TURBT was used to compare the two procedures. Clinical data, including age, gender, tumor characteristics, operation duration, hospitalization, irrigation, catheterization, and intraoperative and postoperative complications, were recorded. There were no significant differences in age, gender, mean tumor size, mean tumor number, tumor location, or risk between the TmLRBT and PK-TURBT groups. The TmLRBT group was associated with a significantly shorter operation duration (25.96 ± 21.19 min vs 37.18 ± 25.77 min, P = 0.018) and a shorter hospitalization time (3.11 ± 1.05 days vs 5.24 ± 2.06 days, P = 0.036). The postoperative irrigation time (6.33 ± 4.05 h vs 14.76 ± 6.28 h, P = 0.027) and catheterization time (2.03 ± 1.61 days vs 4.27 ± 1.17 days, P = 0.035) in the TmLRBT group were lower than those in the PK-TURBT group. No significant differences in fever and rebleeding were found in the TmLRBT and PK-TURBT groups. There were no significant differences in the overall, low-risk, intermediate-risk, and high-risk recurrence-free rates between the two groups (P = 0.43, P = 0.68, P = 0.71, and P = 0.24, respectively). The proportion of bladder detrusor muscle (BDM) identified in pathologic specimens of the TmLRBT group was higher than that in the PK-TURBT group (P = 0.006). TmLRBT may reduce operation duration time, hospitalization time, postoperative irrigation time, and catheterization time. TmLRBT is considered safer and more effective in treating primary NMIBC. Recurrence-free rates did not differ between groups.
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Affiliation(s)
- Kewei Li
- Department of Urology, Qilu Hospital, School of Medicine, Shandong University, Jinan, 250000, Shandong, China.,Department of Urology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, 100 Haining Rd, Hongkou District, Shanghai, 200080, China.,Department of Urology, Zhucheng People's Hospital, Zhucheng, 262200, Shandong, China
| | - Yongzhi Xu
- Department of Urology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, 100 Haining Rd, Hongkou District, Shanghai, 200080, China.,School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Mingyue Tan
- Department of Urology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, 100 Haining Rd, Hongkou District, Shanghai, 200080, China
| | - Shujie Xia
- Department of Urology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, 100 Haining Rd, Hongkou District, Shanghai, 200080, China
| | - Zhonghua Xu
- Department of Urology, Qilu Hospital, School of Medicine, Shandong University, Jinan, 250000, Shandong, China
| | - Dongliang Xu
- Department of Urology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, 100 Haining Rd, Hongkou District, Shanghai, 200080, China. .,Department of Urology, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Jingan District, Shanghai, 200003, China.
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21
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Kang M. Transurethral Resection of Bladder Tumors. Bladder Cancer 2018. [DOI: 10.1016/b978-0-12-809939-1.00009-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kramer MW, Altieri V, Hurle R, Lusuardi L, Merseburger AS, Rassweiler J, Struck JP, Herrmann TR. Current Evidence of Transurethral En-bloc Resection of Nonmuscle Invasive Bladder Cancer. Eur Urol Focus 2017; 3:567-576. [DOI: 10.1016/j.euf.2016.12.004] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 12/05/2016] [Accepted: 12/09/2016] [Indexed: 11/29/2022]
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Comparison of the efficacy and feasibility of laser enucleation of bladder tumor versus transurethral resection of bladder tumor: a meta-analysis. Lasers Med Sci 2017; 32:2005-2012. [DOI: 10.1007/s10103-017-2308-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 08/08/2017] [Indexed: 01/03/2023]
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Wu YP, Lin TT, Chen SH, Xu N, Wei Y, Huang JB, Sun XL, Zheng QS, Xue XY, Li XD. Comparison of the efficacy and feasibility of en bloc transurethral resection of bladder tumor versus conventional transurethral resection of bladder tumor: A meta-analysis. Medicine (Baltimore) 2016; 95:e5372. [PMID: 27828864 PMCID: PMC5106070 DOI: 10.1097/md.0000000000005372] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The aim of this meta-analysis was to compare the feasibility of en bloc transurethral resection of bladder tumor (ETURBT) versus conventional transurethral resection of bladder tumor (CTURBT). METHODS Relevant trials were identified in a literature search of MEDLINE, EMBASE, Cochrane Library, Web of Science, and Google Scholar using appropriate search terms. All comparative studies reporting participant demographics, tumor characteristics, study characteristics, and outcome data were included. RESULTS Seven trials with 886 participants were included, 438 underwent ETURBT and 448 underwent CTURBT. There was no significant difference in operation time between 2 groups (P = 0.38). The hospitalization time (HT) and catheterization time (CT) were shorter in ETURBT group (mean difference[MD] -1.22, 95% confidence interval [CI] -1.63 to -0.80, P < 0.01; MD -0.61, 95% CI -1.11 to -0.11, P < 0.01). There was significant difference in 24-month recurrence rate (24-month RR) (odds ratio [OR] 0.66, 95% CI 0.47-0.92, P = 0.02). The rate of complication with respect to bladder perforation (P = 0.004), bladder irritation (P < 0.01), and obturator nerve reflex (P < 0.01) was lower in ETURBT. The postoperative adjuvant intravesical chemotherapy was evaluated by subgroup analysis, and 24-month RR in CTURBT is higher than that in ETURBT in mitomycin intravesical irrigation group (P = 0.02). CONCLUSION The first meta-analysis indicates that ETURBT might prove to be preferable alternative to CTURBT management of nonmuscle invasive bladder carcinoma. ETURBT is associated with shorter HT and CT, less complication rate, and lower recurrence-free rate. Moreover, it can provide high-qualified specimen for the pathologic diagnosis. Well designed randomized controlled trials are needed to make results comparable.
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Affiliation(s)
| | | | | | - Ning Xu
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Correspondence: Dr Ning Xu, Department of Urology, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Fuzhou, Fujian 350005, China (e-mail: )
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Rouprêt M, Neuzillet Y, Masson-Lecomte A, Colin P, Compérat E, Dubosq F, Houédé N, Larré S, Pignot G, Puech P, Roumiguié M, Xylinas E, Méjean A. Recommandations en onco-urologie 2016-2018 du CCAFU : Tumeurs de la vessie. Prog Urol 2016; 27 Suppl 1:S67-S91. [DOI: 10.1016/s1166-7087(16)30704-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kallidonis P, Kamal W, Panagopoulos V, Vasilas M, Amanatides L, Kyriazis I, Vrettos T, Fligou F, Liatsikos E. Thulium Laser in the Upper Urinary Tract: Does the Heat Generation in the Irrigation Fluid Pose a Risk? Evidence from an In Vivo Experimental Study. J Endourol 2016; 30:555-9. [DOI: 10.1089/end.2015.0768] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Wissam Kamal
- Department of Urology, University of Patras, Patras, Greece
| | | | | | | | - Iason Kyriazis
- Department of Urology, University of Patras, Patras, Greece
| | - Theofanis Vrettos
- Department of Anesthesiology and ICU, University of Patras, Patras, Greece
| | - Fotini Fligou
- Department of Anesthesiology and ICU, University of Patras, Patras, Greece
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“En Bloc” Resection of Nonmuscle Invasive Bladder Cancer: A Prospective Single-center Study. Urology 2016; 90:126-30. [DOI: 10.1016/j.urology.2016.01.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 12/29/2015] [Accepted: 01/05/2016] [Indexed: 11/19/2022]
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Kramer MW, Wolters M, Herrmann TRW. En Bloc Resection of Bladder Tumors: Ready for Prime Time? Eur Urol 2016; 69:967-8. [PMID: 26806657 DOI: 10.1016/j.eururo.2016.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 01/05/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Mario W Kramer
- University of Luebeck, Department of Urology, Luebeck, Germany.
| | - Mathias Wolters
- Hanover Medical School, Department of Urology and Urological Oncology, Hannover, Germany
| | - Thomas R W Herrmann
- Hanover Medical School, Department of Urology and Urological Oncology, Hannover, Germany
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Affiliation(s)
- Thomas R W Herrmann
- Division of Endourology and Laparoscopy, Hanover Medical School (MHH), Dept. of Urology and Urological Oncology, Carl Neuberg Str. 1, Hanover, 30625, Germany,
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Emiliani E, Herrmann TRW, Breda A. Thulium laser for the treatment of upper urinary tract carcinoma (UTUC)? Are we there, yet? World J Urol 2015; 33:595-7. [DOI: 10.1007/s00345-015-1511-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 02/09/2015] [Indexed: 02/02/2023] Open
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En bloc resection of urothelial cancer within the urinary bladder: the upcoming gold standard? World J Urol 2015; 33:581-2. [DOI: 10.1007/s00345-015-1498-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 01/24/2015] [Indexed: 11/27/2022] Open
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Kramer MW, Wolters M, Cash H, Jutzi S, Imkamp F, Kuczyk MA, Merseburger AS, Herrmann TRW. Current evidence of transurethral Ho:YAG and Tm:YAG treatment of bladder cancer: update 2014. World J Urol 2014; 33:571-9. [PMID: 24935098 DOI: 10.1007/s00345-014-1337-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 05/30/2014] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Bladder cancer (BC) represents a growing health care problem worldwide. In times of tight budgets and an aging society, new strategies for the transurethral treatment of BC are needed. Laser devices used for tumor vaporization and/or en bloc resection provide an alternative to parvenu strategies. MATERIALS AND METHODS Medline/Cochrane search was performed using following terms: bladder cancer, urothelial carcinoma, laser, en bloc, vaporization, photoablation, holmium, thulium, Ho:YAG, Tm:YAG, HoLRBT and TmLRBT. Last date of search was February 12, 2014. RESULTS Eighteen publications in English were identified including 800 patients (Ho:YAG = 652 patients and Tm:YAG = 148 patients). Data on en bloc resection techniques were presented in 10 publications, 7 publications provided data of tumor vaporization and one publication presented data on both. Level of evidence based on SIGN is mainly 3 (non-analytic studies); only three studies are level 2 (prospective case control studies). Tumor vaporization seems to be a promising alternative for the treatment of recurrent tumors in selected patients. It can be performed in an office-based approach without the need of general anesthesia. The use of photodynamic diagnostic might enhance surgical quality. The principle of en bloc resection should provide accurate staging in most cases; however, data on this important aspect are missing. Peri- and postoperative complications are scarce. Due to the nature of the energy source, bladder perforation caused by obturator nerve reflex is highly unlikely when using lasers. There is a trend toward decreased infield recurrence rates. CONCLUSIONS Lasers are potentially useful alternatives to conventional TURBT, but systematical assessments using standardized classification systems and well-designed RCTs are needed to make results comparable.
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Affiliation(s)
- Mario W Kramer
- Department of Urology and Urologic-Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany,
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